Sharing post-transplant follow-up care with local oncologists can be safe and effective

March 2025

Patients undergoing allogeneic hematopoietic cell transplant (alloHCT) are at risk for short- and long-term complications such as infections and graft-versus-host disease (GVHD). For those living far from a transplant center, traveling back and forth to get post-HCT care after they return home can add emotional and financial stress. Researchers at Dana-Farber Cancer Institute (DFCI) in Boston evaluated whether patients who received part of their post-HCT care from local oncologists through a shared care model had outcomes comparable to those patients seen exclusively at DFCI.

After returning home from transplant, patients need frequent follow-ups with an oncologist to monitor for complications, have medications adjusted, and potentially receive transfusions. Currently, most patients receive this care at their transplant center, which poses a hardship for those who live far away. This randomized, multisite clinical trial assessed the safety and efficacy of a shared care model between DFCI and local oncology practices in New England and upstate New York.

This study included adults planning to receive alloHCT who lived at least 30 minutes from Boston. From December 2017 to December 2021, 302 patients were randomized 1:1 to receive either usual care or shared care. Patients in the usual care arm received all post-transplant visits in the first 100 days at DFCI in Boston. Patients in the shared care arm alternated visits between DFCI and a local oncology practice near their home. Each local practice had two shared-care oncologists trained in post-HCT care.

The shared care model involved four key strategies for safe local care:

• An online care coordination plan
• Patient engagement and education
• Local oncologist engagement and education
• A web-based communication platform accessible to patients, local oncologists and transplant specialists

Primary outcomes were nonrelapse mortality (NRM) at day 100 (D100) and quality of life (QOL) at day 180 (D180), as measured by FACT-BMT and QLQ-C30 scores. At D100, NRM did not significantly differ between shared care and usual care groups (2.6% vs. 2.7%, p=0.98). Overall survival (OS) at D100 was also similar between groups (94% versus 95%, p=0.62). FACT-BMT scores at D180 were comparable between groups as well.

Secondary outcomes included QOL, acute GVHD and 1-year overall survival (OS). QOL scores at D100 were higher in the shared care groups. Other secondary outcomes showed no significant differences between groups (shared care versus usual care, respectively):

• Grade 2-4 aGVHD: 17.1% versus 16.0% (p=0.72)
• One-year OS: 71% versus 75% (p=0.48)

The study found that shared post-HCT care with local oncologists did not lead to inferior D100 NRM and resulted in similar QOL at D180. Interestingly, D100 QOL was better in the shared care group. These results support that shared care is safe, effective and may enhance early post-HCT QOL. While implementing a shared care model requires training and resources, care coordination, and strong provider-to-provider communication, it could improve access to HCT for patients living far from a transplant center.